In-House Car Loan Promo Online Application Form

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Your Contact Number

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Buying The Car From?
—Car DealerPrivate Individual

Make & Model

Registration Date (dd-mm-yyyy)

OMV

COE Expiry (dd-mm-yyyy)

Selling Price

Deposit (Paid)

Loan Amount

Loan Period (years/months)

Years —1 year2 years3 years4 years5 years Months —0 month1 month2 months3 months4 months5 months6 months7 months8 months9 months10 months11 months12 months

Employer’s Name

Employer’s Address

Job Title

Contact Number

Driving License Pass Date (dd/mm/yyyy)

NCD Entitlement
—YesNo

If yes, please state NCD %
—0%5%10%15%20%25%30%35%40%50%

Vehicle plate no. (the current vehicle that you are driving)

Any claim within 3 years?
—YesNo

If yes, please state information